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Pancreatitis

Pancreatitis is inflammation of the pancreas, an organ in your belly that makes insulin and enzymes that help you digest food. Pancreatitis can cause sudden, severe belly pain. It's usually caused by heavy alcohol use or gallstones.

Most people recover fully from pancreatitis.

  • Symptoms

    What are the symptoms of pancreatitis?

    The main symptom of sudden (acute) pancreatitis is sudden moderate to severe pain in the upper area of the belly (abdomen). Pain may also spread to your back.

    Sometimes the pain is mild. But the pain may feel as though it bores through the belly to the back. Sitting up or leaning forward sometimes eases the pain. Other symptoms of an attack of pancreatitis are:

    • Nausea and vomiting.
    • Fever.
    • Fast heart rate.
    • Sweating.
    • Yellowing of the skin or the whites of the eyes (jaundice).
    • Shock.

    Long-term (chronic) pancreatitis also causes pain in the upper belly.

    Other conditions that have similar symptoms include bowel obstruction, appendicitis, cholecystitis, peptic ulcer disease, and diverticulitis.

  • Causes

    What causes pancreatitis?

    Normally, the structure of the pancreas and the pancreatic duct prevent digestive enzymes from damaging the pancreas. But certain conditions can occur that cause damage and pancreatitis.

    Acute pancreatitis

    Most attacks of pancreatitis are caused by gallstones that block the flow of pancreatic enzymes or by drinking too much alcohol. Sudden (acute) pancreatitis may happen after a drinking binge or after many episodes of heavy drinking.

    Other causes of acute pancreatitis are:

    • Infections, including mumps.
    • Some medicines. These include certain antibiotics, steroids, and blood pressure medicines.
    • Injury.
    • High triglycerides.

    Sometimes the cause isn't known.

    Chronic pancreatitis

    Drinking too much alcohol is the most common cause of ongoing (chronic) pancreatitis.

    Other causes of chronic pancreatitis include cystic fibrosis and a blockage in the pancreas. Chronic pancreatitis may run in families. And smoking cigarettes seems to increase the risk for this disease. In about 1 out of 4 cases, doctors aren't sure what causes it.

    Experts don't know how alcohol irritates the pancreas. Most believe that alcohol may cause enzymes to back up into the pancreas. Or it may change the chemistry of the enzymes. This can cause them to inflame the pancreas.

  • Prevention

    Can pancreatitis be prevented?

    You cannot completely prevent pancreatitis caused by gallstones. But you may be able to reduce your risk of forming gallstones by staying at a healthy weight with a balanced diet and regular exercise.

    You can reduce your chance of having pancreatitis by not drinking alcohol excessively. The amount of alcohol needed to cause pancreatitis varies from one person to another. Generally, moderate consumption is considered no more than 2 alcoholic beverages a day for men and 1 a day for women and older people.

    Smoking may increase your chance of having pancreatitis. If you smoke, it's a good idea to quit.

  • Diagnosis

    How is pancreatitis diagnosed?

    If your doctor thinks that you have pancreatitis, he or she will ask questions about your symptoms and past health and do a physical exam. The doctor will also do blood and imaging tests.

    If your doctor isn't sure if your pancreatic tissue is infected, he or she may use a needle to take some fluid from the inflamed area. The fluid is then tested for organisms that can cause infection.

    In severe chronic pancreatitis, a stool analysis may be done to look for fat in stools. The fat is a sign that you may not be getting enough nutrition. This happens when the pancreas no longer produces the enzymes you need to digest fat.

    Blood tests

    Two blood tests that measure enzymes are used to diagnose an attack of pancreatitis. These tests are:

    Serum amylase.

    An increase of amylase in the blood usually is a sign of pancreatitis.

    Serum lipase.

    Sudden (acute) pancreatitis almost always raises the level of lipase in the blood.

    Other blood tests may be done, such as:

    A complete blood count (CBC).

    The number of white blood cells rises during an attack of pancreatitis. Sometimes the rise is dramatic.

    Liver function tests.

    Increases in liver enzymes, particularly of alanine aminotransferase and alkaline phosphatase, can be a sign of sudden pancreatitis caused by gallstones.

    Bilirubin.

    The level of bilirubin in the blood may increase if the common bile duct is blocked.

    Imaging tests

    Imaging tests that may be done include:

    CT scan with contrast dye.

    A CT scan can help rule out other causes of belly pain, see if tissue is dying (pancreatic necrosis), and find complications such as fluid around the pancreas, blocked veins, and obstructed bowels.

    Abdominal ultrasound.

    This test can locate gallstones. It also can show an enlarged common bile duct.

    Endoscopic retrograde cholangiopancreatogram (ERCP).

    This procedure allows the doctor to see the structure of the common bile duct, other bile ducts, and the pancreatic duct. It's the only diagnostic test that also can be used to treat narrow areas (strictures) of the bile ducts and remove gallstones from the common bile duct. The test may help your doctor see if you have long-term pancreatitis.

    Magnetic resonance cholangiopancreatogram (MRCP).

    This form of MRI can find gallstones in the common bile duct. But this test isn't available everywhere.

    Endoscopic ultrasound.

    In this form of ultrasound, a probe attached to a lighted scope is placed down the throat and into the stomach. Sound waves show images of organs in the belly. This test may find gallstones in the common bile duct.

    MRI.

    Sometimes an MRI is used to look for signs of pancreatitis. It provides information similar to that of a CT scan.

  • Treatment

    How is pancreatitis treated?

    Treatment of pancreatitis depends on whether you have a sudden (acute) attack of pancreatitis or you've had the condition for a long time (chronic).

    Acute pancreatitis

    If you have an attack of pancreatitis, you will get treatment in the hospital to allow the pancreas to heal. You will get fluids through your vein (intravenous, or IV) to replace lost fluids and keep your blood pressure steady. And you will get medicines to control pain until the inflammation goes away.

    Fluids and air can build up in your stomach when there are problems with your pancreas. This buildup can cause severe vomiting. If buildup occurs, your doctor may place a tube through your nose and into your stomach to remove the extra fluids and air. This will help make the pancreas less active and swollen.

    To help rest your pancreas, you probably won't be given anything to eat for several days.

    If gallstones are causing pancreatitis, you may have a procedure called endoscopic retrograde cholangiopancreatogram (ERCP). It removes the stones from the common bile duct. After you recover from pancreatitis, you may have surgery to remove the gallbladder. This surgery often prevents future attacks of pancreatitis.

    Most people get well after an attack of pancreatitis. But problems can occur. Problems may include cysts, infection, or death of tissue in the pancreas.

    Chronic pancreatitis

    People who have chronic pancreatitis also may have acute episodes. They are treated the same as a first episode of acute pancreatitis. Treatment also includes:

    Avoiding alcohol.

    Drinking too much alcohol is the most common cause of chronic pancreatitis. It is extremely important that you not drink any alcohol. Drinking even small amounts can cause severe pain and complications. Drinking large amounts of alcohol when you have chronic pancreatitis can shorten your life.

    Managing pain.

    If you have chronic pancreatitis, you may struggle with ongoing pain. Treatment for pain includes avoiding alcohol, eating a low-fat diet, and using pain medicine. In some cases, you can take enzyme pills to help rest your pancreas.

    Surgery.

    Surgery is avoided when possible because the pancreas is damaged easily. But you may need surgery or another procedure:

    • If infection develops. Surgery can remove the infected and dead tissue.
    • To widen a narrow pancreatic duct or to remove tissue or stones that are blocking the duct.
    • If you have complications from acute or chronic pancreatitis.
    • If there's no infection and your condition hasn't improved.
    • To drain a pseudocyst or an obstructed duct.
    Enzyme pills.

    In advanced chronic pancreatitis, your body may not absorb fat. This causes loose, oily, very foul-smelling stools (called steatorrhea). You may lose weight. This is because your pancreas no longer makes the enzymes you need to digest fat and protein. Pancreatic enzyme pills can replace lost enzymes.

    Antibiotics.

    You may need antibiotics if you get an infection.

    Insulin.

    You may need insulin if your pancreas has stopped producing enough of it.

    Your doctor will want to see you regularly. He or she will make sure that your pain medicine is helping you and that you don't have complications of chronic pancreatitis. Complications may include symptoms that keep flaring up, fluid buildup, and blockage of a blood vessel, the bile duct, or the small intestine. Chronic pancreatitis also increases your risk of pancreatic cancer.

    Making lifestyle changes to help manage chronic pancreatitis may seem hard. But with planning, talking with your doctor, and getting support from family and friends, these changes are possible.

  • Self-care

    How can you care for yourself when you have pancreatitis?

    If you have ongoing (chronic) pancreatitis caused by excessive use of alcohol, you will need to quit drinking to reduce severe pain and complications. Drinking large amounts when you have chronic pancreatitis can shorten your life.

    Although the role of diet in pancreatitis is not clear, doctors recommend eating a low-fat diet and staying at a healthy body weight.


    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.